A new drowning research agenda (for high-income countries) Joost J.L.M. Bierens MD PhD MCDM...
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Transcript of A new drowning research agenda (for high-income countries) Joost J.L.M. Bierens MD PhD MCDM...
A new drowning research agenda
(for high-income countries)Joost J.L.M. Bierens MD PhD MCDM
AnesthesiologistMaatschappij tot Redding van Drenkelingen
(Society to Rescue People from Drowning, established 1767)
WHY RESEARCH
• to describe
• to understand
• to replace impressions by data
• to improve quality of performance
• to obtain political support
• to obtain financial support
• to demonstrate professionalism
• to give the best care to the victim
Important drowning research domains
1. Epidemiology
2. Prevention
3. Rescue
4. Pathophysiology
5. Resuscitation
6. Education
Most of all:
national, all-inclusive and multidisciplinary
registration of fatal and non-fatal drowning
should be initiated
Two basic principles of data registration
Clearly define the objective of the registration
• Operational data: what is happening
• Strategic data: indicators for political and financial issues
• Research data: to improve the current situation
Only include items in a registration that are
• Relevant for the objective of the registration (need to know)
• Available
• Reliable
Drowning research
• Research is a strong instrument to change a situation.
• Most important, and difficult: a relevant research question. The research question defines which data are relevant to collect.
• Make use of:• Definition of drowning (WCOD 2002)• International Classification of Diseases (ICD-codes)• Utstein score for drowning research• Acknowledged clasification systems (over 40)
Example:Study Royal Dutch Lifeboat Institute
Pre-ambule: each year 1200 crew members are (re)trained in first aid, BLS and additional skills to treat submersion, immersion hypothermia, and spine injuries (EHBOplus).
Research question: how often do crew members apply these skills and under which circumstances ?
Results: During 8 years: 17.001 interventions at sea; medical care provided to 131 victims; of which 49 submersion, immersion, hypothermia often in combination with other injuries; 13 persons were resuscitated. 60% in bad weather conditions
Conclusion: after initial first aid and BLS courses, crew should be trained with complex scenarios under realistic circumstances
Important drowning research domains
1. Epidemiology
2. Prevention
3. Rescue
4. Pathophysiology
5. Resuscitation
6. Education
Prevention in low-income countries, 4 drowning intervention
measures have been proven effective close supervisionsurvival swimming lessonsbarriers close to childrenbarriers around water
in high-income countries, the incidence of drowning is too low to measure the effects of interventions
Water competence model
Water competenc
e
Knowledge of dangers
Swimming competence
Behaviour
Aquatic environment
Drowning prevention studies
measure effects of interventions on water competencies (hypothesis: this affects drowning)Open water swimming lessonsCampaigns that point at dangers of alcohol use Information to the public on dangerous situations,
with ICT technologies
measure effects of 16 open water drowning prevention guidelines
Support prevention studies in low income countries
Rescue
Gradually, the requirements for effective rescue are becoming clear
Recognition and detection of a potential drowning victim
Reduction hypoxic period Under water During transport to land Until start CPR
Safety of the rescuer Death Injuries Psychological
• Added value of new rescue equipment
Drowning pathophysiology
In its most simple form, drowning is a respiratory problem.
• hypoxia causes that a healthy heart is braking down
• gradually the heart stops and hypoxic damage to the brain occurs
• drowning cardiac arrest is unlike cardiac cardiac arrest resuscitation – notably VF is rare (0-8%)
• however: drowning has many faces
Research to better understand drowning pathophysiology
Mechanism and sequence of events during hypoxic arrestHeartBrain
Mechanisms and incidence of LaryngospasmAspirationDiving reflexAutonomic conflictCold shock Immersion hypothermia
Research to better understand drowning resuscitation
Animal studies
• Number of initial ventilation before cardiac compressions (2 – 5 – 10?)
• Ventilation - compression ratio
• Compression-only CPR after hypoxic cardiac arrest
• Effect compressions on hypoxic, hypothermic and acidotic heart
Research to better understand drowning resuscitation
Effect of techniques and devices on ventilation, oxygenation, circulation and neurological damage
• Rescue
• In-water ventilation
• Cricoid pressure
• Oxygen
• Supraglottic airway
• AED
• LUCAS
Research to measure drowning morbidity and its relationship with quality of rescue and CPR
• Cardiac consequences• Rhythm• Cardiac performance
• Pulmonary consequences• Pneumonia• ARDS
• Neurological consequences• Neurological outcome• Neurocognitive tests
Resuscitation training research
• How to improve quality of CPR
• Can layperson distinguish between drowning cardiac arrest resuscitation guidelines and cardiac cardiac arrest guidelines
• One-person CPR vs team CPR
• Effect of training under real circumstances on quality of CPR, learning curve, performance, retention and retrieval
To be prepared for research
Use acknowledged definitions, codes, templates and categories
Collaboration with research institutes
International collaboration if needed
Open communication with other researchers
Focus, prioritisation
Management of time and private life